Provider Demographics
NPI:1063885846
Name:MAROUN, DEBORAH ELLEN (LMT, CLT)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ELLEN
Last Name:MAROUN
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 BANKHEAD HWY
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-2401
Mailing Address - Country:US
Mailing Address - Phone:770-834-4599
Mailing Address - Fax:678-664-0013
Practice Address - Street 1:306 BANKHEAD HWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-2401
Practice Address - Country:US
Practice Address - Phone:770-834-4599
Practice Address - Fax:678-664-0013
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT002685225700000X
VA0019002558225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist